[Question #1777] Absolute nightmare

43 months ago
Dear Dr. Hook,
I had written about a exposure 3 months ago regarding protected oral/vaginal intercourse with CSW. I am uncircumised and had only one partner (my wife) before this encounter 5 months ago now.  I had tested negative for HIV 1/2 and HSV 2 37 days postexposure and neg HIV 1 RNA test 50 days postexposure. You told me no further testing was needed. However, I may now have HSV-2 and am freaking out. I noticed a single painful ulcer after 5 months in center of my foreskin while taking shower this evening. I had some burning and tingling feeling for last 5 days but went away when I was not paying attention to it. I did not notice any red bumps or blisters. Just this sudden onset of single midline 2mm ulcer in center of my foreskin. I had sex with my wife (protected) two times in past 5 months. We are pregnant and now I am freaking out I may have given her something. My PCP did not think I needed more testing but now I feel like my life is over. I do not recall any trauma but have been checking myself every 2 hours for past one week before I noticed the ulcer. I don't know what to do and am at a loss. Now I am scared I have contracted HIV-2 as well. Please help.
43 months ago
I did not have any symptoms during first 3 weeks after the encounter 5 months ago for HIV or HSV-2. No grouped red bumps, or blisters which ruptured. No fever and no groin lymph node enlargment. Had negative GC and CT urine test 4 days after encounter as I thought i felt a little burning when I urinated. I am literally freaking out and scared out of my mind. Is this HERPES?? I can't believe I may have it after 5 months and negative HSV-2 test after 37 days. I am really upset I had sex with my wife but was told by you and PCP that I do not have any STDs.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome back to the forum. Dr. Hook and I take questions in sequence, without regard to requests for either of us. Our styles may differ, but our opinions and advice almost never do. I reviewed his discussions with you in your two previous threads.

As you may know, herpes is the single most common cause of genital ulcer. However, the exposure you described in your other threads was low risk for herpes, so probably that's not the explanation. And your previously negative HSV blood test make herpes extremely unlikely. If in fact it is herpes, I would suspect your wife is the more likely source rather than the contact 5 months earlier. Most herpes that appears in monogmous couples does not reflect sexual infidelity, but results from a chronic infection in either partner, only now coming to light. For example, if your wife has had longstanding genital HSV2 from a previous partner, that could explain it. Or she might have oral herpes, going back to childhood, only now making its appearance in you.

All things considered, herpes is unlikely. If you want to be even more confident about it, have another HSV blood test. You could also arrange for testing of your wife. Most likely this is simply a minor traumatic or otherwise unexplained ulcer. But feel free to get tested if you wish and return with the test result, at which time I might have more to say about it.

Regards--  HHH, MD

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43 months ago
Thank you for the reply Dr Handsfield. So my wife has never had any other partner but me so don't think she is a source of HSV 2. Shes also never had any cold sores ever nor have I. I looked at lesion this morning and pretty much closed up within 12 hours of onset. There is slight more redness in area this morning. So on second look this maybe more of a small cut/abrasion then a ulcer. There is a somewhat embarrassing story but when I think back before I noticed this cut but will tell you anyway. I have long pubic hair which gets caught between my glans and foreskin and foreskin folds inward sometimes and traps my pubic hair. I remember that happening yesterday morning and  feeling a sharp pain when yanking on my pubes when going to urinate. So possible could've had a "hair" cut in my foreskin which just opened up more last evening when I felt the stinging pain while taking a shower.  So my questions are:

1) Would a herpes ulcer heal within 12 to 24 hours? Have you seen primary herpes present this way? I don't feel I have recurrence of herpes but did have some prodrome like itching, tingling, burning beginning  5 days before notice lesion. Again, never noticed  any red bump, blister or  cut/ulcer  in past 5 months before yesterday. And was checking very frequently past 5 days due to symptoms. Not sure if prodrome symptoms due to anxiety as when I stopped thinking about it they went away. 
2) I really want to retest HSV 2 but am very paranoid and scared about false positive rates. My 37 day HSV 2  result was less than 0.2. I'm not sure I can mentally handle a low positive from 1 to 3.5 because then I would then need a western blot if my result comes back in that range from what I have read. So, do you feel I should retest anyway 5 months after condom protected exposure?

3) Any chance there could have been micro tears in condom as CSW had braces and we did not change condom prior to vaginal intercourse? Have u seen anyone contract HSV 2 in area where condom was covering skin due to micro tears in Condom from braces? I'm pretty sure condoms didn't break during our two episodes within an hour. She inspected it carefully and they were on my penis both times after finishing.

4) Any chance I have HIV 2 since my blood test was 3rd generation negative after 37 days and neg hiv 1 rna more than 50 days after?  I ask because they did not do hiv 2 RNA.

I just want to move forward and stop thinking about this nightmare. Also, worried to infect pregnant wife and want to resume normal relations with her after this regrettable mistake I made.  Thanks again for helping. 

43 months ago
Sorry Dr. Handsfield. HIV 1 RNA done 44 days postexposure not 50 days. Probably makes no difference but just want to be very precise. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
All this additional information does not change my opinion or advice.

1) Herpes definitely cannot heal so quickly. A herpes lesion requires a minimum of a week, and usually 10-14 days for complete healing. This is additional strong evidence against herpes.

2) Given these circumstances, you don't need to be retested. Don't worry about it. But if you do it, just have the standard IgG test. Western blot is not likely to be needed and it is pointless to worry about that now.

3) "Micro tears" in condoms don't occur, or too rarely to worry about. Even if present, probably not enough infectious fluids could pass through to cause infection. If a condom does not break wide open, protection can be safely assumed to be complete. (By the same token, there is no need for the commonly recommended "water test" after condom protected sex. The idea of microscopic leaks is an urban myth.)

4) Already answered by Dr. Hook. The antibody test would have detected HIV2, and anyway it is exceedingly rare outside the localized area of Africa where HIV2 evolved.

In your other thread, you spoke of your OCD. That is by far the main health problem in evidence. I understand your desire to "move forward and stop thinking about this nightmare". However, simply hearing the facts and odds from us or any other experts is not the way to achieve that. In OCD, there are always "yes but" or "what if" thoughts. Your fears about this are not going to diminish until and unless you manage through counseling. I think I recall from your previous threads that you are in professional treatment for OCD. Continue with it, addressing these events and your fears frankly with your counseor. (If I'm wrong and you're not in care, obviously that is your next step.)

Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future new questions about this exposure, testing, and your fears about HIV, herpes, or other STDs will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers; because experience shows that continued answers tend to prolong users' anxieties; and because such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.



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43 months ago

Thank you for the response Dr. Handsfield.

1) So what do you think of my prodromal symptoms? I had pain in left side of testicle and shaft and felt some burning and intermittent itching and watery type feel (assuming tingling) at tip of penis 5 days before I noticed this ulcer/cut. Also, had itching in gluteal cleft and scratched till it became a sore. I believe lesions show up where you feel prodromal symptoms, correct? However, my cut/sore was at tip of foreskin. Could this possibly be a recurrence of herpes 5 months after encounter with negative IGG HSV 2 test 5 weeks and 2 days after encounter? Do you think this is all in my head? Can anxiety cause this?

2) Dr. Hook stated only 90% of infections are confirmed after 37 days from exposure using 3rd generation technology. I did not have HIV-2 test after 37 days. Only HIV-1 RNA negative after 44 days. So, theoretically, I can still have 10% chance of HIV-2 that wasn't picked up by 3rd generation antibody testing.

3) I guess I had worry about contracting HSV 2 ever since the encounter 5 months ago, so any abnormality on my penis freaks me out especially when I noticed the cut/ulcer yesterday evening. Still stings a little today especially when I get urine on it as I don't retract foreskin when I urinate but has been less than 24 hours since I noticed it and looks more healed than yesterday evening. What do you think caused this cut/ulcer in center of foreskin? I have dry skin in general. Could me examining myself A LOT this past week cause breaks in skin or an episode of masturbation 2-3 days prior have caused it ( I never use lubrication)? Do I need to get it swabbed? Should I see my PCP to look at it? What would you do?? If this sore/cut heals up completely within 3-4 days, maybe I won't get another HSV 2 IGG test for fear of false positive.

4) I stopped talking to my counselor as it was a family member doing her psych residency and did not feel comfortable telling her this stuff. She was trying to help me with general OCD symptoms. She suggested an anti depressant but I am hesitant to take any meds.

5) Finally, with all the information I have provided, would YOU have unprotected sex with your spouse or significant other without ANY fear of infecting them or unborn child? That is the million dollar question.

I hope you keep this thread open in future if I ever do get another HSV 2 IGG and HIV test so I may report it. Hopefully they will be negative. Thanks for all you do. Have a great day.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
1) Those symptoms do not sound like a herpes prodrome. Among other things, prodrome doesn't last more than 1-2 days before the visible outbreak begins.

2) I would have said ~95% test reliability at 37 days, not a significant difference from Dr. Hook's 90% estimate. But your calculation of odds is way off base. Chance your partner had HIV2, let's say 1 in 100,000. Chance you caught it if she did, with condom protected sex, maybe 1 in 10,000. If we also assume a 10% chance the test missed a new HSV2 infection, the chance you have it is 0.00001 x 0.0001 x 0.1 = 0.0000000001. If I've counted the zeros correctly, that's one in 10 billion. That means zero.

3) You're a better judge than I can be about whether repeated exam, perhaps with stretching your penile skin, or masturbation, could explain the sore you saw. Otherwise, this is a quite irrational statement. You'd be OK getting the sore swabbed to document HSV2, and yet fearful of having a blood test for the same purpose.

4) Resume counseling with an independent, non-family counselor.

5) If somehow I were in your situation, I would never have stopped having unprotected sex with my wife and would not have been tested for anything. For sure you can do that now.

Sorry, the standard policy is to close threads after two follow-up comments and replies (i.e. 3 total exchanges) and this thread will be closed. In the event you ever have a positive HSV2 IgG test, feel free to ignore my comment above and start a new thread about it. Otherwise that policy will be followed, e.g. if another HSV test is negative.

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